What to Know Before Going Under the Knife

Editor's Note: We first published this article a few years ago, and it's gotten a lot of feedback from both women considering surgery and cosmetic surgeons. So we re-edited it with advice from Dr. Martin Jugenburg of Toronto Cosmetic Surgery Institute, a plastic and reconstructive surgeon, who came across the article recently and reached out to us.

Dr. Jugenburg, also known as Dr.6ix, is actually a big deal. He's been a ringside surgeon for the UFC and a trusted resource for reporters dishing the details on growing procedures like butt lifts. We're honored to add his wisdom on this topic.

Masking Mosquito Bites

Good girls don't get fake boobs. They train hard. They eat well. And then they let Mother Nature take care of the rest. That was my thinking before getting breast implants.

Then one day it occurred to me: My boobs have been fake since the seventh grade, but back then they were made of cotton. Mom said I was just a late bloomer. But by age 29 nothing had changed, and I was still wearing the same sized bra.

I felt deformed, embarrassed, and jealous of women who had breasts. It wasn't an easy decision to get implants, but neither was trying to look normal as a 5'10" muscular female hiding mosquito bites in NA-sized bras (that's Nearly-A cup).

It was frustrating to have a mismatched body. I wasn't a small woman. Why did I have small breasts? I just wanted to be proportional and there was nothing I could do to get them bigger naturally.

Extra body fat went straight to my thighs, and even at my heaviest, I still wore an NA-cup. Boobs can't be trained on, dieted on, supplemented on or even drugged on. For women looking for better proportions, the only choice is surgery.

So I discussed it with my husband, slept on it for many nights, then booked a consultation with a doctor to learn more. I scoured the internet for advice from other female lifters, but couldn't find much.

It was like they were too embarrassed to go public about their augmentation. Most bikini and figure competitors had them, yet no one talked about them.

Boobs will never go out of style. And many of us are simply not born with a voluptuous chest. So why not discuss the details? If you're kicking the idea around, here are the big things you'll need to know about bigger boobs.

How Do I Choose a Doctor?

Dr. Jugenburg says, "Look for someone who can show you a lot of before and after photos; not just his best 10. You want to see other women who look like you in the before photos, so you can see what they end up looking like after. Then ask for long-term photos. One year after. Because anyone can look great shortly after surgery."

Cosmetic surgery is not the time to be frugal, so be ready to spend somewhere between $5,000 and $7,000 in total. Be suspicious of anything cheaper. Consultations are usually free, so try visiting multiple doctors and go with the one who makes the most sense or makes you feel the most comfortable.

The best surgeon won't encourage you to go huge or just take your money and throw in whatever you ask for. He should want his work to look tasteful, balanced, and aesthetically pleasing, so that when you tell other women about it they'll want what you have, and hire him.

My surgeon turned down women who wanted to look like they were shoplifting basketballs. Your surgeon may have you bring in pictures of tatas you admire. I did that, but while I was under the knife, he tested out different sizes inside of me to see what would look the most proportional with my frame. Find a doctor who routinely does that.

What's Best: Over or Under the Muscle?

This is one of the first things that women tend to worry about, but you really don't need to stress over it. Your surgeon will be able to help you make the best choice given your genetics, preferences, and biggest concerns. Here are the pros and cons of each:

Under: Pros

Natural looking for extremely small-chested women.

No perfectly round headlights.

Under: Cons

Much longer recovery time.

Much more pain if you have a lot of pec muscle.

Chest exercises can cause "animation deformity."

Over: Pros

If you have more natural breast tissue they'll look natural.

Recovery is faster and less painful.

Over: Cons

More obvious if you're extremely lean, have thin skin, or little to no natural breast tissue.

Some surgeons will refuse to place implants over the muscle if there's not enough breast tissue there or very thin skin on your chest. Getting them under the muscle simply conceals the implant better if you've got nothing to work with.

When I went in for my first appointment I was dead set on getting implants over the muscle. But the surgeon explained that I didn't have enough breast tissue and they would look like obvious headlights if he placed them over the pecs. So we went with under.

However, Dr. Jugenbug doesn't fully agree with my surgeon's decision. He says, "...going under was the dogma for several years, but now the hottest topic at cosmetic surgery meetings is about implants going over the muscle.

"Going under the muscle is not just about looking more natural. In a lean patient, with a thin pectoral muscle, the muscle adds very little coverage to hide the implant. You will still see the implant. The main benefit of going under the muscle is lower risk of capsular contracture. The risk is small, but going under the muscle has an even lower risk (of an already low risk) than going over the muscle."

And while what he says makes perfect sense, I can tell the difference between my (under the muscle) augmented chest and the chest of women who got their implants over the muscle. They're two different looks, in my opinion, and when done right, both can be aesthetically pleasing.

Something else to keep in mind: With implants under the muscle, it's normal to see the implants spread while you're using your pec muscles. According to Dr. Jugenburg, this is called animation deformity. He says, "In my experience, fitness and bodybuilding women who get this hate it and want their implants repositioned to the sub glandular space."

I guess my mindset is that lifting is for building muscle and strength. Not really for demonstrating how natural your (totally unnatural) boobs look. Maybe wear a T-shirt on chest day?

On the bright side, if a perv at the gym is looking at your chest while you're on the pec deck, and if you happen to be wearing a plunging neckline, you might freak him out a bit. This is both a pro and a con.

What About the Risks?

I'll let the doctor sum it up:

"Realize that no surgery is without a risk. The two best things you can do to minimize risk are...

Select a reputable surgeon and clinic who puts an emphasis on safety and won't cut corners to compete on price.

Make sure you follow your surgeon's pre- and post- op instructions to a T. Realize that a perfectly beautiful result can be destroyed during the recovery if you do not follow the post-op care instructions."

As for potential ruptures, Dr. Jugenburg says, "The newest silicone implants are more cohesive, like a gummy bear, so should you have an implant rupture, the silicone will just sit there instead of leaking out."

Capsular contracture is another thing you might hear about. The capsule is just the lining that forms around the implant (good); contracture is what happens when that lining hardens and creates too much scar tissue (bad).

According to Dr. Jugenburg, "Risk of capsular contracture goes down when the surgeon uses a meticulous technique, uses an insertion device such as the Keller Funnel when using silicone implants, and patients follow careful post op instructions."

So when you go for a consultation, consider asking the surgeon if he uses a Keller Funnel.

Implant migration is another rare thing that can happen. Some female lifters say that their implants have migrated outward because of weight training, but medical professionals will tell you that migration happens randomly, and it happens to non-lifters just as often. I was told not to let the concern of migration impact my lifting.

Other risks occur when a female decides to start exercising too soon after surgery – yoga, weight training, dancing, running, you name it. Tissues need time to heal and collagen needs time to rebuild. Activity too soon can cause a blood vessel to pop and fill the breast up with blood. This would result in a hematoma and an expensive "re-operation" to fix what happened.

Patience is breast insurance. Even if you think you're good to start working out, give it the full amount of time that your doctor recommends. The better you are at waiting, the better they'll look when you're fully recovered.

How Big Should I Go?

According to Dr. Jugenburg, "Choosing the implant size is the most agonizing decision most women make, going back and forth 5ccs."

"First, realize that plus or minus 50cc will barely make a difference. So don't sweat it over 5ccs. Second, trust your surgeon. He or she should choose an implant that fits your body, which means the dimensions of your implants fit your breast width. If you chose an implant that's too small, it will look like a large lump in your breast. If you chose a very large implant, side-boob will get in the way of your arms' movements."

His advice makes sense, and while it's a personal decision, you want people to say, "Wow, look at that super fit woman!" Not "Hey, look at that stripper over there doing lunges!"

If you train hard to make your body look amazing, why would you want your breasts to be the most prominent feature on your body? Get implants to complement your hard work, not overshadow it.

And another thing: Do you compete? Cool. Doesn't matter. Think of your life beyond the competition. Will you want larger breasts then? Never get cosmetic surgery just to please others – including judges. Make sure it's a wise investment for your life, not just the stage.

With that said, there aren't many pro bikini competitors with flat chests. And while enormous fun bags aren't a prerequisite you'll find in the official judging criteria, everybody seems to know that if you've got your heart set on going pro in bikini, your boobs will probably need to be set on it too.

Figure and physique competitions are a lot more forgiving in the boobs department. There are plenty of competitors who've competed and turned pro without enhancement.

How Will They Look?

Chests are just as diverse as faces. Women who have breasts that are spaced far apart won't have inner cleavage, even after augmentation. Women who have breasts that are closer together will have cleavage. Their nipples will be narrower as opposed to pointing outward.

Genetics determine where boobs are on the chest and what direction the nipples point. The surgeon can't rearrange your nips, so if your breasts are structurally spread wide apart on your chest then they'll remain that way. Don't freak if your sweater puppies point outward. The tradeoff for great cleavage is great side-boob. Both structures have their benefits.

By the way, your new love muffins won't settle in for weeks. Especially if they were inserted under the muscle. You're going to be very swollen too for quite a while so they'll look a little weird at first. Like footballs or alien aircraft.

Don't judge the final look of your breasts until six weeks after. Your doc may even take "after" pics somewhere around six weeks after your surgery.

How Do I Stay In Shape During Recovery?

The first couple days will be all about rest and recovery. If your surgeon went under the muscle, then plan to take it easy for six weeks. Rein in your diet. Edit out unnecessary indulgences. Remember, you won't be holding loaded barbells, dumbbells, or using any upper body machines for six weeks so your appetite won't be raging anyway.

If you got them over the muscle you'll be able to ease into training sometime after two weeks. But recovery time is really an individual thing. As a point of reference, my implants were under the muscle and this is how my fitness timeline went:

For the first four days I slept.

For the rest of the first four weeks I walked an hour a day.

Around the four week mark I eased into training legs in machines.

After six weeks, I began training upper body with no direct chest work.

After two months I was able to do direct chest work with no issue.

I didn't go all-out on upper body for about three months.

What About Pain?

What the plastic surgery websites won't tell you is that if you get your implants under the muscle, and if you have a lot of muscle on your chest, you will be in excruciating pain.

For me, that pain was almost constant for a month. It only subsided when I was on heavy duty pain killers and sitting very still. A girlfriend of mine got hers over the muscle and said she felt great within three days.

Another thing you won't find on the breast implant websites is what those heavy duty meds do to your digestive system. Just in case, have something on hand that alleviates constipation. I didn't poop for a week after surgery.

Pain will depend on how big your implants are. Many surgeons will require you to get moderate-sized implants before you get monster-sized implants because you're having to stretch your body's tissues in order to accommodate the extra stuff.

If the implants are going under the muscle, that's more tissue getting stretched. Women who get a breast lift and augmentation at the same time will experience more pain simply because of the extra work being done.

When you come home from the procedure you won't feel anything, and you might not be conscious. But that first week you definitely will be feeling it. If you're not married, recruit your mom or a friend to help you around the house.

Keep in mind that breast pain later on may not be caused by the implants, though that's what we tend to blame first. But even women without breast implants experience pain in their breasts, which can be caused by a whole host of things, including monthly hormonal fluctuations.

What About My Job?

Breast augmentation is considered a day surgery, no overnight stay required unless there's a complication. You won't want to go back to work the day after you get them either.

Ideally, if you work weekdays, get them on a Thursday and go back to work on a Monday. If your job requires lifting of any kind, try to take more time off and ask your doctor for advice.

Can I Stop Training Chest If I Get Implants?

Don't let bigger love pillows keep you from building bigger pecs. Muscle definition on the female chest is a sign of leanness and heavy training, so you'll want to keep that around.

Muscle separation between the chest and the delt is stunning and it'll complement your bigger boobs by building muscle in the area. And remember, bench presses and dips work a lot more than just your pecs.

Keep training the area after you're enhanced so that your chest will stand out for the work you've done on it. Just make sure you're fully recovered first.

What about Sex and Everyday Life?

Sex increases blood pressure, so to avoid the risk of a hematoma, abstain for two weeks. The likelihood of wanting to get it on shortly after surgery will be slim. You'll be propped up in bed at night and you won't want your pillow set-up moving a whole lot. Even getting into bed will be an ordeal and it might be wise to sleep alone for the first few nights. Life and sleep will start getting back to normal after two weeks.

Some women complain of losing sensitivity in their nipples or having nipples that are painful to the touch years after surgery. If that's a major concern for you, then talk to your doctor about it.

If you're not one who enjoys the nips being touched in the first place, then that risk is inconsequential. Keep your spouse or significant other from trying to do anything fancy with your boobs for six weeks.

What about Scars?

To minimize scarring, avoid tanning for a full year while the scar tissue is building. Dr. Jugenburg says, "Wearing a T-shirt or a high SPS is good but not perfect. Put tape over the scars, even if you're wearing a T-shirt." I wasn't diligent about that in my tanning-bed days, and wound up with dark scars, which was super dumb.

The location of the scarring will depend on the incision site and your skin's ability to repair itself.

Axillary incision: Near the armpit. There won't be scarring on the boob, but there will probably be scarring on the armpit area.

Inframammary: Under the boob. This is the most common incision site because it doesn't endanger the functions of the breast: pleasure and breast feeding. Under the boob scars are common but not noticeable unless you're topless. Bikinis hide them well.

Peri-areolar: Under the areola. Scarring here isn't noticeable, but surgeons often avoid this area because there's a greater risk of complications, like capsular contracture.

What are the Biggest Perks?

Confidence. Confidence in the bedroom. Confidence wearing the clothes you like. Confidence at the gym when you catch a glimpse of your curves. A great rack is like an accessory that you never have to take off. Life without padded bras is pretty sweet.

Decision Time

If you feel beautiful without implants, save your money. But if every outfit you put together requires a Houdini-boob strategy, if you feel self-conscious during sex, or discouraged about wearing the things you want to wear, then it's something to think about.

Yes, you can absolutely have a beautiful body with nonexistent boobs. But the way you feel about that body is what matters the most.